Chronic Sinus Headaches

@ajoutwest-Hi. What you are experiencing is being “felt” in the sinuses, however it is not sinus related. Most “sinus headaches” are not sinus headaches at all. It is an inflammatory response that happens in the gut/intestinal lining and presents in the sinus/nasal cavity. This is the reason why sprays/rinses did not work for you.
The main cause of gut disbiosis is stress. Stress in the form of regular life/emotional stress, environmental and foods. If you go to the ENT, they will not educate you on this as for one, they are highly uneducated on exactly why inflammation happens in the sinus/nasal cavity to begin with. They only have one way of thinking and that is either bacterial or external allergens. They are also surgeons, so if you have nothing of interest structural to them that they can cut into, then they will give you some pamphlet about allergies and tell you to be on your way.
You working in a healthcare system, knows how this works. It’s not that this is strange per se, it’s just that these specialists can’t bill insurance or code for something that is not billable, like patient education. Your nasal/sinus lining is the same lining that lines your throat all the way down to your stomach. If your gut does not have the proper foods/enzymes to keep a healthy environment, inflammation begins. Such as acid reflux/silent reflux which can all back up into the sinus lining, especially while sleeping. This is why if someone drinks milk, they can feel congestion. Or as you mentioned alcohol, red wine and sugary drinks. This all causes congestion. Congestion is a natural response to your gut not agreeing with acidity/high inflammatory foods. The good news is,you sound like you know your body very well and how it responds. I would stay out of the health care system and work with someone like a Functional med/Natural path doctor to better understand you as an entire system and not just separate parts. They can help you understand which foods cause high acidity/glycemic index/inflammation and help you get your gut/microbiome in balance. There are many things that can help. Too many to list. But to start you can look into the relationship between the small intense and sinusitis. Do not put anymore things in your nose, which is only compromising your healthy natural bacteria in there.
ENTs would have empty offices if more people knew how the rest of their body effects sinuses. Hope this helps.

I always find your comments enlightening even if I don't always agree entirely. I definitely agree that mainstream medicine fails many people with chronic problems and the specialist system does not encourage a holistic viewpoint. But I find it very difficult to identify functional/natural practitioners I can have faith in. There are so many variations on the theme and I suspect a host of charlatans ready to prey on desperate patients. It seems to me to be as difficult to identify such a practitioner as it is to find an understanding mainstream physician.

@ajoutwest I'd like to extend my welcome to Mayo Clinic Connect, along with @nrd1 @bride.

I can't comment on @nrd1response because I'm not medically trained but I'm wondering if you have you considered seeking a therapist to help manage stress and in turn your symptoms? I would not discourage you to continue to look for an organic source for your issue. Sometimes the best we can do is manage symptoms while looking for medical answers. Other alternative treatments such as acupuncture have efficacy regarding symptom management. Mindfulness and yoga can also be helpful in managing stress and hopefully bring your symptoms to a more manageable level, while you look for answers.

I'd like to invite members like @vickim @naney @alaethia @woogie @yasmeen @lioness to join the conversation because they have discussed a similar topic related to ENT.

It sounds like you have been incredibly diligent and proactive in your quest to find answers. It must be discouraging to still not have the answers you need.

I'm wondering if you have seen other providers for a second opinion, at a teaching or specialty hospital?

@bride-thank you for your feedback. Of course there is a place for traditional medically trained professionals. And even with the Functional/ND approach you have to be diligent in your search as well. However most medically trained professionals don’t often spend the time to ask enough questions to understand the entire person and or provide the proper education to improve. Prescriptions don’t always need to be in the form of pills. Often times the best prescriptions can be education so you have the tools to get yourself in optimal health for you.
As @erikas mentioned mindfulness and yoga. This helps the body is so many ways to benefit all systems.

@ajoutwest- I did forget to mention, if you speak to a headache clinic/migraine specialist (not saying at all you have migraines) they can explain to you how the vasomotor reaction is part of the sympathetic nervous system. When this part of the nervous system is activated this can result in tension (vasoconstriction) which can show up in vasomotor rhinitis, tension headaches, migraines, reflux etc...they all share a commonality. Ask them about certain vitamin deficiencies as well. Hopefully a neuro/headache specialist can explain the correlations between these sensations and the why’s behind them.

Thanks, Erika. The stress part was wildly out of control in my early thirties. Since then, I've been on a journey of recovery and healing that has taken that from a 10 on a 10 scale to what is probably a 2 on most days. That's part of why I'm seeking additional help as that major piece has largely been ameliorated. What is strange is that now a baseline of headache and inflammation has become a constant and I'm more sensitive than before to the triggers.

In my research today, I found an encouraging study by the University of California at San Francisco (Sinus Microbiome Diversity Depletion and Corynebacterium tuberculostearicum Enrichment Mediates Rhinosinusitis). That's the article title if anyone wants to read it :)h
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and some possible practical applications: lactobacto dot com, that are worth testing out. These relate to gut and sinus biome.

I've seen 3 providers, had a CT scan, blood panel, but no real help. The ENT scanned me, and because he couldn't do surgery to fix it, just sent me out the front door. We do have a functional med office in the Denver area folks rave about, so I may try them out.

One other interesting health history fact was that I was sick with a staph infection from about 6 months old until I was 2 years old. I received a bi-weekly penicillin shot--so basically loaded with antibiotics while my body was developing. This, along with other elements, is leading me toward looking more into gut health.

@ajoutwest With your symptoms and history of past treatments, it makes since to explore any avenue that may help you feel better.

I don't normally talk about personal health issues but I wanted to share because your situation sounds so similar to mine.

I had headaches since I was 4. I had a headache 24/7, always. I was in a car accident when I was 4 and I had abdominal surgery. When I was 25 I started to have visual distortions. It was scary and I thought I was losing my mind or had MS. I went to a neurologist and had a lot of tests done. I had an MRI, EKG, hearing test, and a bunch others. Nothing was found wrong. I was given amitriptyline and now I live a normal life of no headaches and no visual distorions. Never. I do believe that my visual distortions were related to anxiety but also my baseline headaches, possibly migraines with aura wasn't helping my situation. Amitriptyline changed my life. I can't give you medical advice but it's food for thought.

@ajoutwest Welcome to you and glad youfound this forum. I have been dealing with burping and hiccups also a pain on right side of my esophagus . Since I had a ulcer a long time ago I contacted my Dr. I have always had to watch what I eat no fried food ,spicy food ,acid from ornages or coffee,tea so I became suspecious when I had acid reflux. Right away my Dr felt it was my stomach flaring up again so she put me on Nexium which is a great pill I feel as this is what healed my ulcer . Stress that we are all living in right now hasn't helped with numerous problems so you have to get your stress level down as you know stress increases your cortisol level . So however you can reduce your stress level . I find for myself Tai Chi and qigong help me , daily walking outside just getting in nature will help . I hope you find something here helpful . take care

@ajoutwest 20 years ago I was having debilitating sinus headaches.. I even had to go to the emergency room for pain shots that would knock me out.. An ENT Surgeon in Central Iowa, who is now retired, did a surgery on me that straightened my nose (septum) and cut a new hole to drain one of the sinus cavities that would be filled with mucus and such but could not drain...He told me I was to stay hydrated and use saline nose sprays as well but the prescribed a non-steroidal nose spray for allergy called "Azelastine" ... that does the trick ... it does not lose its potency like over the counter nose sprays.. I have been using it for decades now.. The tree pollens in spring and the crop dust in the fall make the situation worse.. I use it after giving my nose a saline spray to help things flow properly.. I have not had one of those debilitating headaches since that ENT surgery.. Ken

@ajoutwest, I noticed that you wished to post a URL to a journal article with your message. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe. Clearly the link you wanted to post is not spam, so allow me to post it here.

- Sinus Microbiome Diversity Depletion and Corynebacterium tuberculostearicum Enrichment Mediates Rhinosinusitis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786373/

@ajoutwest- I do want to point out that @erikas brings up a very good perspective on sharing her personal experience.

It does sound like you’ve been very through and you know your body very well. Don’t lose sight of the headache portion. They can manifest for so many different reasons.
The ultimate headache specialist is a Neurologist. They will ask lifestyle questions, onset of headache, location, etc...
They know the cranial nerves. Often, their first line treatment will be a low dose amytriptiline or something similar. These have also helped people with perceived congestion or ear fullness. They are not sure why but they do. A conversation with a Neuro could be a good step on your healing journey.